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F0677
D

Failure to Provide Scheduled Showers and Honor Resident Bathing Preferences

York, Pennsylvania Survey Completed on 05-22-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide adequate personal hygiene and grooming in accordance with resident preferences for two residents who were dependent on staff for assistance with activities of daily living. One resident, with diagnoses including muscle weakness, chronic diastolic heart failure, and diabetes mellitus type II, reported not receiving scheduled showers on multiple occasions. Documentation confirmed missed showers on several scheduled days, and grievances were filed by the resident regarding these missed showers. Investigations into the grievances revealed issues such as staff shortages and miscommunication regarding the resident's shower schedule, as well as documentation errors related to the electronic kiosk and Kardex updates. Another resident, with a history of cerebral infarction, COPD, diabetes, contracture, muscle weakness, vascular dementia, and cognitive communication deficit, expressed a preference for showers over bed baths and required a Hoyer lift and staff assistance for bathing. Despite this preference being documented in the care plan and discussed in care plan meetings, the resident received bed baths instead of showers on some scheduled days due to insufficient staffing. Interviews with staff and review of documentation confirmed that the resident and her family had to advocate for showers, and the care plan indicated the importance of honoring the resident's bathing preference.

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